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Biomedical subjects

V Lehtinen

Publications and source records attributed to V Lehtinen.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of compliance with psychological interventions offered in the community.

BACKGROUND: This study sought to evaluate the acceptance of two brief psychological interventions for depressed individuals, contacted through a community survey, and to look for predictors of adherence at the patient level. METHOD: The authors used data from the Outcomes of Depression International Network (ODIN) study, which included a randomized controlled trial in which depressed individuals from five European countries, and nine geographical areas were assigned to one of three groups: individual problem-solving treatment, group psychoeducation, or control group. In this analysis, we included all of the individuals who had been assigned to one of the psychological interventions. Compliance with intervention was defined in two different ways. Multiple logistic regression was used to see which variables might predict an individual's compliance with psychological treatment. RESULTS: Psychological intervention was offered to 236 subjects. Treatment was completed by 128 subjects and not by 108 (compliance definition A). Three variables were found to have an effect on compliance A: the presence of a confidant, the use of antidepressant medication during the previous 6 months, and the previous use of any social or health services. On the other hand, 164 subjects had agreed to at least start the treatment, and 72 had not (compliance definition B). The three factors associated with compliance B were presence of a confidant, previous use of services, and the 'desire for change' score. CONCLUSIONS: Social support and previous use of services are the main predictors of compliance with a psychological treatment in depressed individuals from the community. Implications for clinical practice and community programs are discussed.

Adult↗
PubMed2003

Involuntary medication in psychiatric inpatient treatment.

The aim of this study was to examine involuntary medication in psychiatric inpatient treatment. A retrospective chart review of 1543 consecutive admissions of working aged civil patients from well-defined catchment areas to three psychiatric centres were evaluated regarding events of involuntary medication. 8.2% of the admissions included involuntary medication episode(s). Involuntary medication was associated with a diagnosis of schizophrenia, involuntary legal status and having previously been committed. One of the studied centres used less involuntary medication than the other two, even if patients with schizophrenia were over-represented in that centre. Although involuntary medication mainly takes places in the treatment of patients who are conceptualised most ill and perhaps resist treatment most, treatment culture obviously also plays a role. In future, it is important to study the aspects of treatment culture to fully understand the use of involuntary medication in psychiatry.

Adolescent↗
PubMed2003

The use of harmful to others-criterion for involuntary treatment in Finland.

During the past decades the Western countries have paid attention to their Mental Health legislation, in particular, by making changes concerning involuntary treatment. In Western countries legislation allows involuntary treatment of the mentally ill. Involuntary psychiatric treatment is motivated by either potential harm to others (for the good of society) or by need for treatment and/or potential self-harm (for the good of the patient). The aims of this study were to describe to what extent the danger to others criterion is used as a motivation for involuntary hospitalization and detainment in Finland, and to what kind of patients this criterion is applied. The study involves a retrospective chart review of all the treatment periods of a six month admission sample in three Finnish university hospitals. We found that potential harm to others has been rarely used as a motivation for involuntary referral or detainment together with other motivations, and virtually never as the sole motivation. With the exception of gender, which was most often male, patients with potential harm to others did not differ significantly from other involuntarily treated patients. Coercion (defined as seclusion, the use of restraints, forced medication, physical restraint or restrictions in leaving the ward) was not used with these patients more regularly than with the patients motivated by the other criteria. Length of stay (LOS) in a psychiatric hospital did not differ between the patients determined harmful to others and the other involuntarily treated patients.

Adolescent↗
PubMed2003

Estimating psychological treatment effects from a randomised controlled trial with both non-compliance and loss to follow-up.

BACKGROUND: The Outcomes of Depression International Network (ODIN) trial evaluated the effect of two psychological interventions for the treatment of depression in primary care. Only about half of the patients in the treatment arm complied with the offer of treatment, prompting the question:'what was the effect of treatment in those patients who actually received it?' AIMS: To illustrate the estimation of the effect of receipt of treatment in a randomised controlled trial subject to non-compliance and loss to follow-up. METHOD: We estimated the complier average causal effect (CACE) of treatment. RESULTS: In the ODIN trial the effect of receipt of psychological intervention (an average of about 4 points on the Beck Depression Inventory) is about twice that of offering it. CONCLUSIONS: The statistical analysis of the results of a clinical trial subject to non-compliance to allocated treatment is now reasonably straightforward through estimation of a CACE and investigators should be encouraged to present the results of analyses of this type as a routine component of a trial report.

Data Interpretation, Statistical↗
PubMed2002

Duration of untreated psychosis and its correlates in first-episode psychosis in Finland and Spain.

OBJECTIVE: To examine the association of duration of untreated psychosis (DUP) with early course characteristics in first-episode psychosis in Finland and Spain. METHOD: Eighty-six patients from Finland (49) and Spain (37) were evaluated on various early course characteristics. RESULTS: The mean value of DUP was 4.0 months (median 2 months) for the Finnish patients and 9.9 months (median 2 months) for the Spanish ones. In both groups, long DUP was associated with insidious onset, poor global functioning, and laboral incapability. Among the Finnish patients exclusively, long DUP correlated with a weak earlier social network, instability of professional identity, long duration of prodromal symptoms, psychological dependency on the family, and criticism by the parents of the patient. Among the Spanish patients only, longer DUP was associated with more severe positive symptoms at admission. CONCLUSION: There are universal psychosocial factors influencing DUP, but also cultural differences may have an impact on the treatment delay.

Adolescent↗
PubMed2001

Depressive disorders in Europe: prevalence figures from the ODIN study.

BACKGROUND: This is the first report on the epidemiology of depressive disorders from the European Outcome of Depression International Network (ODIN) study. AIMS: To assess the prevalence of depressive disorders in randomly selected samples of the general population in five European countries. METHOD: The study was designed as a cross-sectional two-phase community study using the Beck Depression inventory during Phase 1, and the Schedule for Clinical Assessment in Neuropsychiatry during Phase 2. RESULTS: An analysis of the combined sample (n=8.764) gave an overall prevalence of depressive disorders of 8.56% (95% CI 7.05-10.37). The figures were 10.05% (95% CI 7.80-12.85) for women and 6.61% (95% CI 4.92-8.83) for men. The centres fall into three categories: high prevalence (urban Ireland and urban UK), low prevalence (urban Spain) and medium prevalence (the remaining sites). CONCLUSIONS: Depressive disorder is a highly prevalent condition in Europe. The major finding is the wide difference in the prevalence of depressive disorders found across the study sites.

Adolescent↗
PubMed2001

Mental disorders and cause-specific mortality.

BACKGROUND: The impact of clinically diagnosed mental disorders on mortality in the general population has not been established. Aims To examine mental disorders for their prediction of cause-specific mortality. METHOD: Mental disorders were determined using the 36-item version of the General Health Questionnaire and the Present State Examination in a nationally representative sample of 8000 adult Finns. RESULTS: During the 17-year follow-up period 1597 deaths occurred. The presence of a mental disorder detected at baseline was associated with an elevated mortality rate. The relative risk in men was 1.6(95% confidence interval 1.3-1.8) and in women, 1.4 (95% Cl 1.2-1.6). In men and women with schizophrenia the relative risks of death during the follow-up period were 3.3 (95% Cl 2.3-4.9) and 2.3 (95% Cl 1.3-3.8) respectively, compared with the rest of the sample. In both men and women with schizophrenia the risk of dying of respiratory disease was increased, but the risk of dying of cardiovascular disease was increased only in men with neurotic depression. CONCLUSIONS: Schizophrenia and depression are associated with an elevated risk of natural and unnatural deaths.

Adult↗
PubMed2001

Integrating mental health services: the Finnish experience.

The aim of this paper is to give a short description of the most important developments of mental health services in Finland during the 1990s, examine their influences on the organisation and provision of services, and describe shortly some national efforts to handle the new situation. The Finnish mental health service system experienced profound changes in the beginning of the 1990s. These included the integration of mental health services, being earlier under own separate administration, with other specialised health services, decentralisation of the financing of health services, and de-institutionalisation of the services. The same time Finland underwent the deepest economic recession in Western Europe, which resulted in cut-offs especially in the mental health budgets. Conducting extensive national research and development programmes in the field of mental health has been one typically Finnish way of supporting the mental health service development. The first of these national programmes was the Schizophrenia Project 1981-97, whose main aims were to decrease the incidence of new long-term patients and the prevalence of old long-stay patients by developing an integrated treatment model. The Suicide Prevention Project 1986-96 aimed at raising awareness of this special problem and decreasing by 20% the proportionally high suicide rate in Finland. The National Depression Programme 1994-98 focused at this clearly increasing public health concern by several research and development project targeted both to the general population and specifically to children, primary care and specialised services. The latest, still on-going Meaningful Life Programme 1998-2003 which main aim is, by multi-sectoral co-operation, to improve the quality of life for people suffering from or living with the threat of mental disorders. Furthermore, the government launched in 1999 a new Goal and Action Programme for Social Welfare and Health Care 2000-2003, in which mental health has been chosen as one of the eight priority areas.

Journal Article↗
PubMed2000

Problem solving treatment and group psychoeducation for depression: multicentre randomised controlled trial. Outcomes of Depression International Network (ODIN) Group.

OBJECTIVES: To determine the acceptability of two psychological interventions for depressed adults in the community and their effect on caseness, symptoms, and subjective function. DESIGN: A pragmatic multicentre randomised controlled trial, stratified by centre. SETTING: Nine urban and rural communities in Finland, Republic of Ireland, Norway, Spain, and the United Kingdom. PARTICIPANTS: 452 participants aged 18 to 65, identified through a community survey with depressive or adjustment disorders according to the international classification of diseases, 10th revision or Diagnostic and Statistical Manual of Mental Disorders, fourth edition. INTERVENTIONS: Six individual sessions of problem solving treatment (n=128), eight group sessions of the course on prevention of depression (n=108), and controls (n=189). MAIN OUTCOME MEASURES: Completion rates for each intervention, diagnosis of depression, and depressive symptoms and subjective function. RESULTS: 63% of participants assigned to problem solving and 44% assigned to prevention of depression completed their intervention. The proportion of problem solving participants depressed at six months was 17% less than that for controls, giving a number needed to treat of 6; the mean difference in Beck depression inventory score was -2. 63 (95% confidence interval -4.95 to -0.32), and there were significant improvements in SF-36 scores. For depression prevention, the difference in proportions of depressed participants was 14% (number needed to treat of 7); the mean difference in Beck depression inventory score was -1.50 (-4.16 to 1.17), and there were significant improvements in SF-36 scores. Such differences were not observed at 12 months. Neither specific diagnosis nor treatment with antidepressants affected outcome. CONCLUSIONS: When offered to adults with depressive disorders in the community, problem solving treatment was more acceptable than the course on prevention of depression. Both interventions reduced caseness and improved subjective function.

Adolescent↗
PubMed2000

Coercion and restrictions in psychiatric inpatient treatment.

To find out to what extent coercion and restrictions are used in psychiatric inpatient treatment and with which patient characteristics the use of coercion is associated. To this end, the hospital records of 1,543 admissions (six-month admission samples) to the psychiatric clinics in three Finnish university towns were evaluated by retrospective chart review. The study clinics provide all psychiatric inpatient treatment for the working-age population in their catchment areas. Use of coercion and restrictions was recorded in a structured form. Coercion and restrictions were applied to 32% of the patients. Mechanical restraints were used on 10% of the patients, and forced medication on 8%. Compared to international statistics the figures in the current study are high.

Adolescent↗
PubMed2000

Two-year outcome in first-episode psychosis treated according to an integrated model. Is immediate neuroleptisation always needed?

In this multicentre study the two-year outcome of two groups of consecutive patients (total N = 106) with first-episode functional non-affective psychosis, both treated according to the 'need-specific Finnish model', which stresses teamwork, patient and family participation and basic psychotherapeutic attitudes, was compared. No alternative treatment facilities were available in the study sites. The two study groups differed in the use of neuroleptics: three of the sites (the experimental group) used a minimal neuroleptic regime whilst the other three (the control group) used neuroleptics according to the usual practice. Total time spent in hospital, occurrence of psychotic symptoms during the last follow-up year, employment, GAS score and the Grip on Life assessment were used as outcome measures. In the experimental group 42.9% of the patients did not receive neuroleptics at all during the whole two-year period, while the corresponding proportion in the control group was 5.9%. The overall outcome of the whole group could be seen as rather favourable. The main result was that the outcome of the experimental group was equal or even somewhat better than that of the control group, also after controlling for age, gender and diagnosis. This indicates that an integrated approach, stressing intensive psychosocial measures, is recommended in the treatment of acute first-episode psychosis.

Adolescent↗
PubMed2000

Differences between patients with identified and not identified psychiatric disorders in primary care.

OBJECTIVE: The aim of this study was to discover the differences between the primary care patients with a psychiatric disorder whose illness was detected and the patients whose disorder was not detected. METHOD: We collected 1000 randomly selected PC patients. We used SCL-25 as a screening method and PSE as a diagnostic tool. RESULTS: Ninety-one (89.2%) of the interviewed patients received a psychiatric diagnosis. The physicians detected a disorder in 36 (36.9%). A larger part of the undetected group belonged to the highest social groups. Also the SCL-25 mean scores differed significantly, indicating that the symptoms of the undetected cases were milder. The detected cases had higher levels of anxiety and depression, but the difference in anxiety symptoms was greater between the groups. Detection was associated with treatment. CONCLUSION: The GPs should also be aware of psychiatric morbidity in patients with a higher social status, a good level of education and milder symptoms.

Adolescent↗
PubMed1999

Organizing ODIN: a case study in European academic co-operation. The ODIN Group.

The European Commission is an increasingly important source of funding for international research projects and is due to announce its Framework 5 program early in 1999. The Outcomes of Depression International Network (ODIN), funded from the current EC Biomed 2 program, is a case study in European academic co-operation. Its organization has three key elements. First, engaging the principal investigators: this has involved identifying potential partners, ensuring reciprocity of interests, effective co-ordination, 'dividing the spoils' in advance, and setting up good personal and electronic communication systems. Second, an esprit de corps has been created amongst the researchers, maintaining contact and consistency, and promoting higher degrees. Third, ongoing problems including difficulties in negotiations with the EC, divergence of detailed study methods, and isolation and demoralization amongst researchers, have been addressed. ODIN may provide a useful model for researchers wishing to set up international collaborative groups.

Academic Medical Centers↗
PubMed1999

Mortality among discharged psychiatric patients in Finland.

No comprehensive study has yet been made of mortality among psychiatric patients in Finland. According to studies conducted in other parts of the world, the mortality rates of psychiatric patients are higher than those of the general population. The study population here consisted of all patients discharged from psychiatric hospitals during the year 1988 (n = 22940). The register follow-up of these patients extended up to the year 1992. In the course of the follow-up a total of 3936 discharged psychiatric patients died (17.2%). The standardized mortality ratio (SMR) of the patients discharged from psychiatric hospitals was almost four times higher than that of the general population. The proportion of unnatural causes of death, including accidents in the young age groups and especially the much higher suicide SMR among young women, is a particularly striking finding. Natural causes of death were also more prevalent among the study population than in the general population, the major causes being acute myocardial infarction and unspecified pneumonia. The results of this study confirm previous findings of increased mortality among psychiatric patients compared to the general population. On the basis of this study one cannot, however, conclude that the reason for the high mortality rate would be premature discharge. More attention needs to be paid to the care of young patients and to supporting the patient during the transition from the hospital to community care.

Adult↗
PubMed1998

Schizophrenia among patients treated for rheumatoid arthritis and appendicitis.

The widely accepted negative association between schizophrenia and rheumatoid arthritis (RA) is based on the results of investigations which sought RA in large samples of schizophrenic patients. Using a discharge register, we examined the frequency of schizophrenia in a sample of 5626 RA patients. Appendicitis patients (n = 5330) were used as a comparison group. The cumulative incidence of hospital care with the diagnosis of schizophrenia during 8 years was higher in the RA group (0.64%) than in the appendicitis group (0.47%). Schizophrenia was significantly more common in the RA group than in the appendicitis group among the young. The age-adjusted prevalence of schizophrenia was 0.96% in the RA group and 0.51% in the appendicitis group. Because of this unexpected finding, we examined the incidence of RA and appendicitis among a birth cohort born in 1966. The frequencies of RA and appendicitis among schizophrenic cohort members (n = 76), cohort members with psychiatric diagnosis other than schizophrenia (n = 438), and members without psychiatric diagnosis (n = 10503) were similar. These findings do not support the negative association between schizophrenia and RA. Prolonged institutionalization per se may have been the protective factor against RA in the previous studies. The findings also raise the hypothesis that genes that predispose to schizophrenia provide protection from appendicitis, historically a common cause of mortality.

Adolescent↗
PubMed1998

Patterns of psychiatric hospital service use in Finland: a national register study of hospital discharges in the early 1990s.

We were interested in studying the possible concurrent changes in the psychiatric inpatient population during a rapid phase of deinstitutionalisation, and severe economic recession with a record level unemployment rate, and after the amendment of the mental health legislation. Although there were 4540 fewer beds in the psychiatric hospitals in 1993 compared to 1990, the rate of patient admissions remained the same. There was a significant increase in readmissions (P < 0.001) to the psychiatric hospitals, and particularly in multiple (three or more) readmissions among new inpatients (P < 0.001). The prevalence of inpatients with major depression increased by 0.2/1000 in the whole cohort and by 0.12/1000 among first-timers from 1990 to 1993 (P < 0.001). In addition, the rate of involuntary admissions decreased significantly (P < 0.001).

Adolescent↗
PubMed1998

Frequently hospitalised psychiatric patients: a study of predictive factors.

The purpose of this study was to investigate the factors predicting readmission and the interval between readmissions to psychiatric hospital during the early 1990s in Finland. Data were retrieved using the national register of all discharges from psychiatric hospitals during the early 1990s. Frequently admitted patients were an identifiable group. The factors associated with an increased risk of multiple readmissions were: previous admissions, long length of stay (LOS) and diagnosis of psychosis or personality disorder. Patients with psychosis or personality disorder were also readmitted more rapidly than patients with an organic disorder. There seemed to be a small proportion of psychiatric patients in need of frequent or lengthy hospital treatment. The expansion of community care did not as such seem to have diminished the need and use of psychiatric hospital care. However, the differences between the years 1990 and 1993 were less important than the other factors that predicted readmission, namely LOS and diagnosis.

Adult↗